Predictors of therapy failure in a series of 741 adult pyogenic liver abscesses

Lo, Joseph Zhi Wen; Leow, Jeffrey J.; Ng, Perryn Ling Fei; Lee, Hui Qi; Noor, N.A. Mohd; Low, Jee Keem; Junnarkar, Sameer P; Woon, Winston

doi:10.1002/jhbp.174

Cited by 74 publications

(92 citation statements)

References 53 publications

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“…In our cohort, 50 % of MPLPs were larger than 5 cm in diameter and 29 % were multiple. Despite these unfavorable factors, the overall fatality rate in our cohort was 4%, which was equal to or better than rates reported in previous studies about PLAs (Table 2) [1,2,22,23,28]. Fatality rates did not differ between MPLP and drainable PLA groups in our cohort.…”

Section: Discussionsupporting

confidence: 55%

“…Cryptogenic-origin routes were defined as having no identifiable source of infection despite extensive explorations. Preexisting comorbidities included diabetes mellitus, alcoholic abuse, prior gastroduodenal ulcer, prior abdominal surgery, cardiovascular diseases (hypertension, ischemic heart disease, stroke), and chronic renal failure, all of which have been reported to be associated with PLA fatality [1,2,22,23].…”

Section: Data Collectionmentioning

confidence: 99%

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Multilocular Pyogenic Liver Abscess with Poorly Liquefied Content: A Potential Therapeutic Concern

Morii¹,

Yamamoto²,

Nakamura³

et al. 2017

GHOA

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Background: Percutaneous catheter drainage (PCD) is currently the preferred therapeutic procedure of pyogenic liver abscesses (PLAs). However, multilocular poorly liquefied PLAs (MPLPs) are unsuitable for PCD. As reports on MPLPs are scarce, we aimed to explore possible therapeutic strategies for this serious type of PLA. Methods:The medical records of patients with PLA who were hospitalized at our institution between January 2011 to December 2015 were retrospectively reviewed. Demographic factors, biochemical, bacteriological, and imaging results, and treatment outcomes were evaluated.Results: Fourteen patients with MPLPs and 37 with drainable PLAs were identified and included in the study. Clinical characteristics were generally similar between the two groups. Klebsiella pneumoniae accounted for the majority of the culprit pathogens in MPLPs. Patients with MPLPs were managed medically without PCD. Despite this, treatment outcomes were not inferior compared to patients with drainable PLAs. Contrast-enhanced images revealed that the intricate septa of the MPLP maintained its blood perfusion. Most MPLPs did not liquefy over the treatment period. Conclusion:We should remember that MPLP is not rare. The septa may have delivered antibiotics adequately into the MPLPs, thus producing good treatment outcomes. Despite our findings, a high level of suspicion of treatment failure is crucial in these patients to ensure favorable treatment outcomes.

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Section: Discussionsupporting

confidence: 55%

Section: Data Collectionmentioning

confidence: 99%

Multilocular Pyogenic Liver Abscess with Poorly Liquefied Content: A Potential Therapeutic Concern

Morii¹,

Yamamoto²,

Nakamura³

et al. 2017

GHOA

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“…[23][24][25] This study developed a simple survival risk score using five baseline independent predictors associated with mortality from liver abscess in Thailand. Those parameters were age, chronic kidney disease, cirrhosis, HIV infection, and etiology of liver abscess.…”

mentioning

confidence: 99%

Burden of Liver Abscess and Survival Risk Score in Thailand: A Population-Based Study

Poovorawan¹,

Pan-ngum²,

Soonthornworasiri³

et al. 2016

The American Society of Tropical Medicine and Hygiene

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Abstract. In Thailand, the burden of liver abscess, a life-threatening infectious disease, has not been thoroughly evaluated. We developed a predictive scoring system to estimate survival of patients with liver abscess using information from the 2008-2013 Nationwide Hospital Admission Data to evaluate the burden of liver abscess in Thailand. All patients with primary diagnosis of pyogenic liver abscess (PLA) and amoebic liver abscess (ALA) were included. Epidemiological data, baseline characteristics, hospital course, and survival were analyzed. Overall, 11,296 admissions comprising 8,423 patients from 844 hospitals across Thailand were eligible for analysis. The mean age was 52 ± 17 years and 66.1% of patients were male. ALA was significantly prevalent in southern and western border regions of Thailand, and PLA occurred nationwide. The highest incidence of liver abscess occurred in the rainy season (June-November, P < 0.01). The median length of hospital stay was 8 days (interquartile range = 4-13 days), and mean direct cost of hospitalization was 846 ± 1,574 USD. The overall inhospital mortality rate was 2.8%. Incidence of ALA decreased over the 5-year study period, whereas PLA incidence increased (P < 0.01). Using multivariable Cox regression methods with stepwise variable selection, we developed a final model with five highly significant baseline parameters associated with increased 60-day mortality: older age, PLA, underlying chronic kidney disease, cirrhosis, and human immunodeficiency virus infection. Range of estimated probability of 60-day survival was 95-16% at cumulative risk score 0-13. This simplified score is practical, and may help clinicians prioritize patients requiring more intensive care.

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“…The overall experience of management of all 741 patients has been previously published. 26 Forty GPLA patients (24 male, 60%) with a mean age of 57 years (range 35 to 89 years) were included in the analysis. Diabetes and hypertension were the commonest comorbid conditions (n 5 14, 35% each).…”

Section: Resultsmentioning

confidence: 99%

“…The wide variations in outcomes with regards to success of PD and mortality are not solely determined by liver abscess care bundle concept but the geographic and demographic diversity. 26,35 When comparing mortality rates and choice of drainage modality, the severity of illness at presentation should also be considered. For this reason, the use of scoring systems such as Acute Physiology and Chronic Health Care Evaluation II and the simplified acute physiology score II scoring system to estimate the risk of hospital mortality have become increasingly popular.…”

Section: Commentsmentioning

confidence: 99%

Percutaneous drainage for giant pyogenic liver abscess—is it safe and sufficient?

Ahmed

Chia

Junnarkar

et al. 2016

The American Journal of Surgery

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Predictors of therapy failure in a series of 741 adult pyogenic liver abscesses

Cited by 74 publications

References 53 publications

Multilocular Pyogenic Liver Abscess with Poorly Liquefied Content: A Potential Therapeutic Concern

Multilocular Pyogenic Liver Abscess with Poorly Liquefied Content: A Potential Therapeutic Concern

Burden of Liver Abscess and Survival Risk Score in Thailand: A Population-Based Study

Percutaneous drainage for giant pyogenic liver abscess—is it safe and sufficient?

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